Nitric oxide reducing lung and brain injury in preemies

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Specializes in Vents, Telemetry, Home Care, Home infusion.

lung therapy offers hope for preemies

by marie mccullough

inquirer staff writer

july 27th, 2006

babies born very prematurely may be spared lifelong, disabling lung disease if nitric oxide is pumped into their lungs, two national studies have found.

the first study, led by roberta a. ballard, a children's hospital of philadelphia neonatologist, also found that nitric oxide reduced the risk of death and shortened hospitalization.

the second study, led by the university of colorado school of medicine and using a different treatment regimen, found nitric oxide reduced lung disease only in babies who weighed at least 2.2 pounds, but reduced the risk of brain injury in even tinier preemies....

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Specializes in NICU.

I've heard that other units have started using Nitric Oxide in preemies, but right now we only use it in term or near-term babies with PPHN. I was told it was because of FDA approval that we haven't tried it yet with preemies. Anyone else?

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Specializes in NICU, PICU, educator.

We used it in one preemie...the kid had a normal HUS before and a grade IV after.

I know that if you use it outside of the nitric protocols, then your hospital isn't reimbursed the charge for it...we had one kid on it way past protocol and we had to eat the cost!!! $$$$$$

Here is another quote from the article, which kind of proves that our kiddo did bleed from the nitric..

"Because nitric oxide inhibits blood-clotting, it can increase the already substantial danger of bleeding in preemies' brains. Previous studies have shown that the tiniest, most critically ill preterm infants do not benefit from nitric oxide, and one study found it increased their risk of death and severe brain bleeding."

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Specializes in Nurse Scientist-Research.

I saw it given one time (we have to have the children's hospital transport team come over, give it then transport for continued nitric) to a preemie (I don't know the gestational age but he was probably 32-34 weeks by the look/size of him. He was in severe pulm. HTN probably related to his open PDA. Even though he was only hours old he was dying in front of us. No method of ventilation raised his sats above 55% and the only way he was there was being bagged on 100%. Nitric got his sats up above 95% in a couple of minutes. I don't know his final outcome but I do know he was going to die within minutes to hours without it. I was pretty new on our unit so I didn't ask a lot of questions after the fact like I would have now.

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Specializes in NICU, Med/Surg.

Our unit is involved in worldwide study on using NO for preemies. The first criteria is gestational age 24-28 weeks! They start within 12 hours of birth and stay on it for 2 weeks (regardless of ventilator, CPAP or oxygen). The study is a "blind study" so we don´t know if they recieve NO or just air.

We have always used NO on premature children if ventilation is a problem (not on everyone ofcourse). The study is trying to determine if it should be used more and on all babies (premature), regardless if they have ventilation problems or not.

Anna

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Specializes in NICU, Infection Control.

Do you know what other units are trying it?

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Do you know what other units are trying it?

Prmenrs, I believe that Childrens Hospital in Boston is using it. My cousin had a CDH baby and was told that they were set up to use nitric oxide if the baby needed it.

Baby didnt need NO or ECMO. Had surgery 3 days after birth and went home in 5 weeks. He is now 4.5 years, and although his speech (language, to be exact) is quite delayed, he is a normal little boy.

I mention this occurance in my cousins sons life because this is what really fueled the fire regarding my interest in NICU.

ETA: I am sorry prmenrs, where you referring to the study of NO or units that are using NO in general?

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Specializes in NICU, Infection Control.

I mean the study to which Sweden was referring. I know lots of hospitals are using Nitric for term baby issues, but this is a new application.

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Specializes in NICU, Med/Surg.
Do you know what other units are trying it?

I don´t know the other units in the study, but I will try and find out on monday when I am back at work. I think we are suppose to have 10 patients in the study and then we are done......

Anna:typing

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Specializes in NICU.

Our unit definitely uses NO. Not sure if it's on a study basis or not. When I start back (two weeks!) I'll find out and let y'all know.

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Specializes in NICU, Infection Control.

I'm only trying to find out what centers are in the trial. It's used now for Mec asp and other term baby problems. What's new in this trial is the use in preterm babies.

Thanks, Anna!

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I don´t know the other units in the study, but I will try and find out on monday when I am back at work. I think we are suppose to have 10 patients in the study and then we are done......

Anna:typing

Hi sounds very interesting, my unit only uses NO on term babies (MAS or PPHN cases ) it works very well and most of these babies are saved as a result. I'll like to find out more about the study going on in your unit and its findings, do keep me inform, thanks.

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